Ozge Sarac

Differentiation of optic disc edema from optic nerve head drusen with spectral-domain optical coherence tomography.

Background: To assess the efficacy of quantitative analysis of the optic nerve head and peripapillary retinal nerve fiber layer (RNFL) with the spectral-domain optical coherence tomography (SD-OCT) in differentiating optic disc edema (ODE) from optic nerve head drusen (ONHD). Methods: Prospective clinical study. Twenty-five eyes of 25 ODE patients (group 1), 25 eyes of 25 ONHD patients (group 2), and 25 eyes of 25 healthy subjects were included. The thickness of the peripapillary RNFL, the thickness of the subretinal hyporeflective space (SHYPS), the area of the SHYPS, the horizontal length of the optic nerve head, and the angle between the temporal RNFL and the optic nerve head (&agr;-angle) were evaluated with SD-OCT. Results: The mean RNFL thickness was significantly greater in group 1 when compared with group 2 and control group (P < 0.001). The receiver operating characteristic curve areas for temporal and nasal RNFL thicknesses in differentiating group 1 and group 2 were 0.819 and 0.851, respectively (for temporal RNFL thickness >101.5 &mgr;m: sensitivity 92%, specificity 65%; for nasal RNFL thickness >74.5 &mgr;m: sensitivity 92%, specificity 47%). The mean SHYPS thickness, SHYPS area, and degree of the &agr;-angle were greater in group 1 when compared with group 2 (P < 0.05). For the SHYPS thickness >464 &mgr;m: 85% sensitivity and 60% specificity; for the SHYPS area >811 &mgr;m2: 85% sensitivity and 89% specificity; and for the &agr;-angle >141°: 77% sensitivity and 95% specificity were obtained. Conclusion: The quantitative analysis of the optic nerve head and peripapillary RNFL with SD-OCT can provide useful data in differentiating ODE from ONHD.

Topical Cyclosporine in Thyroid Orbitopathy-Related Dry Eye: Clinical Findings, Conjunctival Epithelial Apoptosis, and MMP-9 Expression

Objectives: To evaluate the effects of topical cyclosporine A (CsA) 0.05% (Restasis) on the signs and symptoms of dry eye, on apoptosis, and on MMP-9 expression in conjunctiva epithelial cells in thyroid orbitopathy (TO)-related dry eye patients. Methods: Prospective, clinical study. Twenty-four eyes of 12 consecutive TO patients with dry eye findings instilled CsA twice daily for 2 months. Ocular surface disease index, Schirmer tear test, tear breakup time (TBUT), conjunctival apoptosis index, and conjunctival MMP-9 expression were evaluated before and after 2 months treatment. Conjunctival biopsies were harvested from all eyes at baseline and after 2 months treatment. Apoptosis was detected by the terminal deoxynucleotidyl transferase-mediated dUTP-nick end labeling (TUNEL) assay. MMP-9 expression was determined by immunohistochemistry. Results: After 2 months of topical CsA treatment, the mean OSDI score was significantly decreased from 58.08 ± 6.28 to 36.41 ± 11.75 (P = 0.001). At baseline, the mean Schirmer tear test score was 8.92 ± 5.52 mm. It was increased to 11.25 ± 4.71 mm after treatment (P > 0.05). The mean TBUT increased significantly from 3.92 ± 2.18 sec to 9.16 ± 3.34 sec (P = 0.001). The mean percentage of apoptosis index at baseline was 72.10 ± 35.82%. This was significantly decreased to 53.29 ± 34.46% after treatment (P = 0.008). The mean percentage of MMP-9 expression of the conjunctival epithelial cells was significantly decreased from 48.12 ± 28.58% to 26.66 ± 25.13% following treatment (P = 0.005). Conclusions: Topical CsA treatment appears to improve the signs and symptoms of dry eye and inhibits apoptosis and MMP-9 expression in conjunctival epithelial cells in TO-related dry eye patients after 2 months of treatment.

Ocular Surface and Dry Eye in Graves’ Disease

Purpose: To evaluate the tear function tests and the ocular surface damage in Graves’ disease (GD) patients either with or without thyroid associated orbitopathy (TAO). Methods: Forty-two eyes of 21 randomly selected patients with GD, and 30 eyes of 15 healthy subjects were included in this prospective study. The presence of TAO was evaluated clinically. The palpebral fissure height, degree of proptosis, ocular surface disease index (OSDI), Schirmer tear test, tear break-up time (TBUT), and conjunctival impression cytology were assessed. The results were first compared between the patient and the control groups. Results were then compared between the patients with TAO (group I) and without TAO (group II). Results: The mean OSDI score in the patient group was 44.79 ± 11.83 and it was 21.17 ± 9.89 in the control group (p  =  0.001). The mean Schirmer tear test score was 14.4 ± 8.32 mm and 24.9 ± 3.57 mm in the patient and control group, respectively (p  =  0.001). The mean TBUT in the patient group was 7.1 sec. In the control group it was significantly increased to 10 sec (p  =  0.003). The mean proptosis and interpalpebral distance did not show any difference between the GD patients and controls (p > 0.05). The patients with GD showed significant ocular surface damage in which 75.71% had grade 2–3 squamous metaplasia in temporal interpalpebral conjunctiva. Twenty-four (57%) eyes composed group I. There were no differences in the mean OSDI score, Schirmer tear test score, TBUT, and the amount of ocular surface damage between group I and group II (p > 0.05). Conclusions: Dry eye findings and the ocular surface damage in GD were most likely associated with the ocular surface inflammation. Before the development of the classic findings of TAO, ocular surface inflammation can be the only presenting clinical sign in GD.

Tear eotaxin levels in giant papillary conjunctivitis associated with ocular prosthesis

Purpose: To examine the role of eotaxin and eosinophil recruitment in the immunopathogenesis of ocular prosthesis-associated giant papillary conjunctivitis (GPC). Methods: The tear eotaxin level was measured in 68 eyes with GPC, the fellow eyes of the GPC patients, and 22 normal subjects, using an ELISA method. Upper tarsal conjunctival specimens harvested from 18 patients with GPC were examined by light microscopy. Results: There was no significant difference in tear eotaxin levels between patients with GPC and healthy subjects. In patients with chronic GPC, the tear eotaxin levels were significantly lower. These eyes also had decreased conjunctival cellularity and increased fibrosis in the substantia propria. Biopsy specimens showed infiltration of lymphocytes and mast cells, but no eosinophils were found. Conclusion: Eotaxin and eotaxin-mediated eosinophil recruitment do not seem to have a major role in the immunopathology of chronic GPC associated with an ocular prosthesis.

Mechanical epithelial removal followed by corneal collagen crosslinking in progressive keratoconus: Short-term complications

Purpose To compare the complications occurring within the first 3 months of corneal collagen crosslinking (CXL) performed with mechanical or transepithelial phototherapeutic keratectomy (PTK) epithelial removal in keratoconus patients. Setting Yildirim Beyazit University Ataturk Training and Research Hospital, Ankara, Turkey. Design Nonrandomized retrospective clinical study. Methods Eyes of consecutive progressive keratoconus patients who had PTK or mechanical epithelial removal followed by CXL were included. All patients were examined regularly until epithelial healing. Detailed ophthalmologic examinations were performed preoperatively and 1 and 3 months postoperatively. Results The study comprised 499 eyes (302 patients) that had transepithelial PTK (Group 1, 153 eyes) or mechanical epithelial removal (Group 2, 256 eyes) followed by CXL. Delayed epithelial healing occurred in 15.0% of eyes in Group 1 and 3.5% of eyes in Group 2 (P = .001). Epithelial hypertrophy occurred in 24.8% of eyes and 3.5% of eyes, respectively (P = .001). Salzmann‐like epithelial nodules (2.6%), epithelial herpetic keratitis (1.9%), anterior uveitis (1.9%), and elevated intraocular pressure (1.9%) occurred in Group 1 only and infective keratitis (0.8%) in Group 2 only. Marked stromal edema and peripheral sterile infiltrates occurred at similar rates in both groups (P = .567 and P = .479, respectively). Grade 1+ corneal haze was significantly high in Group 2. Grade 2+ and 3+ haze was significantly high in Group 1 (P = .001). Conclusions Ocular surface healing disorders were the most common early complications of CXL. Short‐term complications were higher with the transepithelial PTK epithelial removal technique than with mechanical epithelial removal. Financial Disclosure No author has a financial or proprietary interest in any material or method mentioned.

Periorbital Necrotizing Fasciitis Caused by Community-Associated Methicillin-Resistant Staphylococcus Aureus Periorbital Necrotizing Fasciitis

Purpose: To report a case of a patient with periorbital necrotizing fasciitis caused by community-associated methicillin-resistant Staphylococcus aureus (MRSA). Methods: Case report. A previously healthy 33-year-old man was presented with pain and rapidly progressive swelling of the right upper eyelid following a minor trauma. Computed tomography scanning revealed soft tissue swelling and fracture of the anterior wall of the right frontal sinus. Oral amoxicillin + klavulanat 1 g, twice daily was started. Over the next 24 hours periorbital necrotizing fasciitis was developed. A wound swab was taken and sent for microscopic evaluation, culture, and antibiotic sensitivity. The patient was started on intravenous crystallized penicillin, third-generation cephalosporin, and metronidazol treatment. An urgent extensive necrotic tissue debridement and frontal sinus curettage were performed. Results: Wound culture yielded MRSA which showed sensitivity to the given antibiotics. The patient responded to the treatment which was continued for 14 days. Conclusions: Monomicrobial MRSA should be considered in the etiology of periorbital necrotizing fasciitis. Early diagnosis and prompt surgical and medical therapy are essential in the management of periorbital necrotizing fasciitis.

The Prevalence of Dry Eye and Sjögren Syndrome in Patients with Migraine.

ABSTRACT Purpose: To evaluate the presence of dry eye and primary Sjögren syndrome (SS) in patients with migraine. Methods: In total, 46 eyes of 46 patients with migraine (group 1) and 50 eyes of 50 healthy subjects (group 2) were included in this study. Detailed ophthalmologic, neurologic and rheumatologic examination were performed on all participants. Ocular surface disease index questionnaire, tear function tests, visual analog scale for pain, serologic analysis were also performed. Results: Dry eye symptoms and findings were significantly higher and more severe in group 1 when compared with group 2. Primary SS was not found in any of the participants. The migraine lifetime duration was negatively correlated with the tear function tests while it was positively correlated with the ocular surface disease index scores. Conclusions: Dry eye symptoms and findings are higher in migraine patients when compared with the healthy subjects without the presence of Sjögren syndrome.

Factors Influencing Progression of Keratoconus 2 Years After Corneal Collagen Cross-Linking in Pediatric Patients

Purpose: To assess the preoperative patient characteristics that may predict outcomes of keratoconus 2 years after corneal collagen cross-linking (CXL) in pediatric patients with keratoconus. Methods: This retrospective study included 72 eyes of 52 consecutive patients with keratoconus under the age of 18 with 2-year follow-up after CXL. Subgroup analysis and cutoff values were determined as per age (<14 and ≥14 years), sex, baseline uncorrected and corrected distance visual acuities (UCVA, CDVA; <0.8 and ≥0.8 logMAR), topographic cone location (central and paracentral), maximum keratometry (K-max, <54 and ≥54 diopters), and corneal thickness at the thinnest point (thCT) (<450 and ≥450 &mgr;m) to evaluate the associations between preoperative patient characteristics and outcomes of CXL treatment in terms of K-max. Postoperative progression in K-max was defined as steepening of 1.0 diopter or more. Results: Average age of patients was 14.8 ± 2.2 (9–17) years. After 2 years, the mean UCVA significantly improved and the mean thCT significantly decreased in all patients (P = 0.023, P < 0.001, respectively). The K-max in patients with paracentral cones and/or with thCT less than 450 &mgr;m were more likely to progress (cone location: P = 0.023, odds ratio = 3.21, 95% confidence interval, 1.17–8.72; thCT: P = 0.008, odds ratio = 4.54, 95% confidence interval, 1.46–14.14). Age, sex, baseline UCVA, CDVA, and K-max did not present any significant effect on progression of CXL after treatment (P > 0.05 for all variables). Conclusions: In pediatric patients with keratoconus, cone location and the baseline thinnest corneal thickness seem to affect the success rate of CXL treatment after 2-year follow-up.

Corneal Biomechanical Properties in Rheumatoid Arthritis.

Purpose: To investigate the variations in biomechanical properties of the cornea in rheumatoid arthritis (RA) patients. Methods: A total of 53 RA patients, and 25 healthy individuals (control group) were enrolled. Rheumatoid arthritis patients were classified as in active phase (group 1; n=24) or in remission phase (group 2; n=29). Corneal biomechanical parameters including corneal hysteresis (CH), corneal resistance factor (CRF), corneal compensated intraocular pressure (IOPcc), and Goldmann-correlated IOP (IOPg) were measured with the Reichert Ocular Response Analyzer. Topographical measurements, including central corneal thickness (CCT), anterior chamber depth, iridocorneal angle, and corneal volume were measured using a Sirius corneal topographer. Results: The mean CH was 9.43±1.17 mm Hg in group 1, 9.42±1.84 mm Hg in group 2, and 10.47±1.68 mm Hg in the control group (P=0.03). The mean IOPcc was 17.85±3.2 mm Hg in group 1, 17.95±3.49 mm Hg in group 2, and 15.36±3.11 mm Hg in the control group (P=0.008). The CH showed a significant positive correlation with CRF (P=0.000, r=0.809) and CCT (P=0.000, r=0.461), and a significant negative correlation with IOPcc (P=0.000, r=−0.469). Conclusions: Decrease in the mean CH measurements indicates that ultrastructural changes in the cornea may occur in the active phase, and these changes persist in the remission period. In addition, IOPcc is significantly affected by the corneal biomechanical properties. In RA patients, it is important to control the corneal parameters and IOP measurements against the irreversible changes on the optic nerve.

Efficacy of intralesional bevacizumab administration in primary pterygium: a quantitative analysis.

Objective: To analyze the regression of the pterygium tissue quantitatively after intralesional bevacizumab administration in patients with primary pterygium. Methods: Thirty-three eyes of 33 patients with primary pterygium who underwent intralesional bevacizumab (1.25 mg per 0.05 mL) administration were included in this prospective study. The ocular irritation, best-corrected visual acuity (BCVA), slit-lamp and funduscopic examinations, corneal astigmatism, the horizontal length, and the thickness of the pterygium were assessed before and after 2 months of treatment. To evaluate the corneal astigmatism and the thickness of the pterygium, the Pentacam comprehensive eye scanner (Pentacam CES; Oculus GmbH) was used. Results: After 2 months of bevacizumab administration, the average BCVA was improved (P=0.003). The average ocular irritation score, horizontal length, and the thickness of the pterygium were statistically significantly decreased (P<0.001, P<0.001, P<0.001, respectively). Conclusion: After 2 months of intralesional bevacizumab administration, the average amount of decrease in the horizontal length and thickness of the pterygium was 0.6 mm and 37 &mgr;m, respectively. Intralesional bevacizumab administration is useful in the management of primary pterygium without having any local or systemic adverse effects; however, repeated administrations are needed to provide clinically more significant results.